Philadelphia's Samuel Dalembert left in the first quarter with a leg injury and didn't return.
Richard Hamilton had 14 points and seven assists for the Pistons, and Antonio McDyess scored 13.
Andre Iguodala had 24 points and Thaddeus Young added 22 for the 76ers.
The lead changed 19 times in the first three quarters, but the 76ers began to take charge late in the third, using an 8-1 run to take a 83-79 lead.
Two quick baskets by Iguodala made it 89-83 with 9:55 left, but Detroit scored the next 10 points for the game's 20th lead change. The Pistons built the margin to as many as six, but Philadelphia pulled to 99-97 on Iguodala's layup with 35 seconds left.
Hamilton, though, hit a baseline jumper with 14 seconds left and the Pistons held on. The Sixers argued that Hamilton had stepped out of bounds, but replays were inconclusive.
Notes: Hamilton, Royal Ivey, Reggie Evans and Iguodala all picked up technical fouls for arguing calls. ... With the Final Four being played 30 miles down I-75, one of the night's biggest cheers came when the scoreboard announced Michigan State's win over Louisville and played the Spartan fight song.
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